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Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis

From the Department of Neurology (O.Y.B.), School of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea; and Departments of Neurology (J.L.S., D.S.L., S.S., B.B., L.A., L.R., T.R., B.O.), Emergency Medicine (S.S.), Radiology (P.V., N.S., F.V., G.D., R.J.), UCLA Medical Center, Los Angeles, CA.

Address correspondence and reprint requests to Dr. B. Ovbiagele, UCLA Stroke Center and Department of Neurology, 710 Westwood Plaza, Los Angeles, CA 90095; e-mail: Ovibes{at}mednet.ucla.edu

Background: Prestroke statin use may improve ischemic stroke outcomes, yet there is also evidence that statins and extremely low cholesterol levels may increase the risk of intracranial hemorrhage. We evaluated the independent effect of statin use and admission cholesterol level on risk of symptomatic hemorrhagic transformation (sHT) after recanalization therapy for acute ischemic stroke.

Methods: We analyzed ischemic stroke patients recorded in a prospectively maintained registry that received recanalization therapies (IV or intra-arterial fibrinolysis or endovascular embolectomy) at a university medical center from September 2002 to May 2006. The independent effect of premorbid statin use on sHT post intervention was evaluated by logistic regression, adjusting for prognostic and treatment variables known to predict increased HT risk after ischemic stroke.

Results: Among 104 patients, mean age was 70 years, and 49% were men. Male sex, hypertension, statin use, low total cholesterol and low-density lipoprotein (LDL) cholesterol, current smoking, elevated glucose levels, and higher admission NIH Stroke Scale (NIHSS) score were all associated with a greater risk of sHT in univariate analysis. After adjusting for covariates, low LDL cholesterol (odds ratio [OR], 0.968 per 1-mg/dL increase; 95% CI, 0.941 to 0.995), current smoking (OR, 14.568; 95% CI, 1.590 to 133.493), and higher NIHSS score (OR, 1.265 per 1-point increase; 95% CI, 1.047 to 1.529) were independently associated with sHT risk.

Conclusions: Lower admission low-density lipoprotein cholesterol level with or without statin use, current smoking, and greater stroke severity are associated with greater risk for symptomatic hemorrhagic transformation after recanalization therapy for ischemic stroke.

Editorial, see page 719

This article was previously published in electronic format as an Expedited E-Pub on December 20, 2006, at www.neurology.org.

Supported by NIH/National Institute of Neurologic Disorders and Stroke P50 NS044378 (J.L.S., L.A., and B.B.).

Disclosure: The authors report no conflicts of interest.

Received July 13, 2006. Accepted in final form October 13, 2006.

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